Can Reducing Nicotine Curtail Smoking?

PITTSBURGH—The question has been kicking around for 20 years: can cutting the amount of nicotine in cigarettes reduce cigarette use and dependence?

Publishing in the New England Journal of Medicine (the same prestigious journal that first entertained the notion), the University of Pittsburgh’s Eric Donny finds that the answer is likely yes. Donny is an associate professor in the Department of Psychology within the Kenneth P. Dietrich School of Arts and Sciences.

In this study, which lasted one year and included 840 participants spread over 10 sites, Donny and collaborators found that nicotine content is a significant determinant of cigarette use and dependence. This is important because the Food and Drug Administration now has the authority to regulate how much nicotine goes in a cigarette.

The double-blind, parallel, randomized clinical trial had participants smoke for six weeks—either their usual brand or one of six investigational cigarettes—that varied in nicotine content from 15.8 mg/g tobacco (typical of commercial brands) to 0.4 mg/g.

When smoking levels were examined at six weeks, the average number of cigarettes smoked per day was lower for participants randomized to 2.4, 1.3, and 0.4 mg/g cigarettes than participants randomized to usual brand and 15.8 mg/g. Reduced nicotine content cigarettes reduced exposure to nicotine, nicotine dependence, and craving when participants were abstinent from cigarettes, Donny says.

But what about “light” cigarettes? Wouldn’t they achieve the same result?

No, says Donny. “Light” cigarettes use the same tobacco—with the same nicotine content—as “full-flavor” smokes. The difference is that “lights” manufacturers use a different filter, more porous paper, and/or punch tiny holes in the paper.

And people, unwittingly most often, get around that by puffing extra hard or covering the holes with their fingers. “And they can end up getting the same amount of nicotine,” Donny says. With these [investigational] cigarettes, there is much less nicotine in the tobacco itself.

Donny is the first author on the paper, which is coauthored by collaborators from a dozen other universities and institutes. The investigators will continue their studies, looking into whether it’s best for smokers to reduce nicotine intake gradually or immediately and whether use of a transdermal nicotine patch in tandem with low-nicotine cigarettes further reduces cigarette use and dependence.